Individual
JENNIFER P BALASKO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
550 S LANDMARK AVE, BLOOMINGTON, IN 47403-3239
(812) 330-3689
(812) 355-3290
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01088877A
IN
390200000X
Student in an Organized Health Care Education/Training Program
11021080A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
090540883
MEDICARE PTAN
IN
05
—
300039270
—
IN
Enumeration date
03/26/2020
Last updated
10/18/2023
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